Modern dentistry aims at preserving the tooth structure in a non- invasive manner. The transition from G V black’s “extension for prevention” to minimal intervention methods paved path for diagnosis of caries during the initial stages of demineralization. Initial caries lesion otherwise called as “white spot lesion” is a subsurface enamel demineralization occurring on the smooth surface of the teeth. “White spot lesion” – coined by FEJERSKOV et al. as – “the first sign of carious lesion that is visible to naked eye”. The white or chalky appearance of the white spot lesion is due to the difference in the scattering of light over the demineralized enamel. Apart from pre-disposing factors like microorganisms, diet and host factors, long term deposition of “undisturbed” plaque helps in the initiation of white spot lesion. These initial carious lesions appear after 4 weeks of demineralization The superficial layer of the enamel remains intact due to the protective action of the salivary proteins, Statherin. Since these salivary proteins are macromolecules, they will not penetrate into the subsurface layer of the enamel and thus its protective action remains confined to the superficial layers. Due to the continuous diffusion of acids, there will be decalcification in the subsurface layer of the enamel. The shape of the white spot lesion depends on the dissemination of the biofilm and enamel prism’s direction. Patients with fixed orthodontic appliance are prone for white spot lesions because of the difficulty in removal of plaque and more areas of “undisturbed” plaque retention. After the removal of appliance, remineralization of the lesion occurs, resulting in hard and shiny appearance of the surface area making the subsurface lesion less visible.
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